Could preoperative rehabilitation modify postoperative outcomes after total hip and knee arthroplasty? Elaboration of French clinical practice guidelines.

OBJECTIVE: To develop clinical practice guidelines concerning preoperative rehabilitation for hip and knee total arthroplasty.
METHOD: We used the SOFMER (French Physical Medicine and Rehabilitation Society) methodology, combining systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, to develop the guidelines. Main outcomes considered in the recommendations were impairment, disability, medico-economic implications and postoperative complications.
RESULTS: A preoperative rehabilitation program, comprising at least physical therapy and education, is recommended before total hip and knee arthroplasty. Occupational therapy could be combined with patient home visits. Isolated physical therapy before total knee arthroplasty (TKA) is not recommended. Multidisciplinary rehabilitation comprising at least occupational therapy and education is desirable for the most fragile patients because of major disability, co-morbidity or social problems. Complementary studies are required to confirm the impact of pre-operative rehabilitation before total hip and knee arthroplasty, to define components of rehabilitation and the patients most likely to benefit.
CONCLUSION: Rehabilitation before total hip and knee arthroplasty contributes to reduced hospital length of and modifying discharge conditions. This rehabilitation necessitates the collaboration of qualified health care professionals in the educational topic and return-home preparation. Preoperative patient assessment is important.